Hand surgery for Dupuytren’s Disease

Living with Dupuytren’s disease, also known as Dupuytren’s contracture, can be challenging. This condition affects the hand, specifically the layer of tissue called the palmar fascia that lies beneath the skin of your palm. Over time, this tissue can thicken and tighten, forming nodules (small lumps) and tough cords. These cords can pull one or more fingers, most commonly the ring and little fingers, causing them to bend inwards towards the palm. While it might start subtly, as the condition progresses, it can significantly impact your ability to perform everyday tasks – from simple things like washing your face or putting your hands in your pockets to more complex activities like gripping objects or placing your hand flat on a table.

While there’s currently no cure that completely eradicates the disease, effective treatments are available to manage the symptoms and improve hand function. For many people, especially when the contracture becomes severe and interferes with daily life, hand surgery for Dupuytren’s disease offers the best chance to straighten the affected fingers and restore functionality. If you’re struggling with the limitations imposed by Dupuytren’s contracture, understanding the surgical options can be the first step towards regaining control.

What is Dupuytren’s Disease and Why Might Surgery Be Needed?

Dupuytren’s contracture develops gradually. It begins with changes in the palmar fascia, the connective tissue layer under the skin of your palm. Initially, you might notice small lumps or nodules under the skin. These are often painless but can sometimes be tender. As the condition progresses, these nodules can develop into thick, rope-like cords that extend into the fingers.

It’s these cords that cause the main problem. They slowly contract and shorten, pulling the affected fingers down towards the palm. This bending, or contracture, makes it difficult or impossible to fully straighten the finger or fingers involved.

When is surgery considered?

Not everyone with Dupuytren’s needs surgery immediately. Treatment decisions depend on the severity of the contracture and how much it affects your daily life. Your doctor or a hand specialist might recommend surgery if:

You can no longer place your hand flat on a surface (this is often checked using the “tabletop test”).
The contracture significantly limits your hand function, making tasks like gripping, holding objects, personal hygiene, or shaking hands difficult.
Non-surgical treatments, such as observation, steroid injections, collagenase injections (an enzyme that breaks down the cord tissue), or needle fasciotomy (a less invasive procedure to divide the cord), haven’t been effective or aren’t suitable for your specific case.
The bent finger is causing practical problems or discomfort.

The primary goal of surgery is to release the tension caused by the thickened cords, allowing the fingers to extend more fully and improving the overall use of your hand.

Exploring Surgical Options for Dupuytren’s Contracture

If surgery is deemed the best course of action, your hand surgeon will discuss the most appropriate procedure based on the severity of your contracture, the specific fingers involved, your overall health, and previous treatments. The main aim is to remove or divide the diseased fascia (the affected tissue) causing the finger to bend. Here are the common types of hand surgery for Dupuytren’s disease:

Fasciectomy: This is the most common surgical procedure for Dupuytren’s contracture. It involves making an incision in the palm and/or finger to remove the thickened cord and diseased fascia. Different types exist:
- Partial Palmar Fasciectomy: The surgeon removes only the affected fascial cord.
- Subtotal Palmar Fasciectomy: This involves removing as much of the diseased fascia and cords as possible to reduce the chance of recurrence. This is a frequently performed and reliable option.
- Dermofasciectomy: In more severe or recurrent cases, the surgeon might remove both the diseased fascia and the overlying skin. This requires a skin graft (taking skin from another part of your body, like the forearm) to cover the area. This procedure has a lower recurrence rate but involves a more complex recovery.
Fasciotomy: In this procedure, the surgeon makes an incision in the skin and simply cuts or divides the tight cord, rather than removing it. This is less invasive than a fasciectomy but may have a higher chance of the contracture returning.
Needle Fasciotomy (also known as Needle Aponeurotomy): This is a minimally invasive, office-based procedure. Using a fine needle inserted through the skin, the surgeon perforates and weakens the tight cord, allowing the finger to be manipulated and straightened. It involves quicker recovery but has a higher rate of recurrence compared to fasciectomy and is only suitable for certain types of cords.

These procedures are typically performed under either local anaesthetic (numbing just the hand), regional anaesthetic (numbing the whole arm, often called a nerve block), or general anaesthetic (putting you to sleep). Your surgeon will discuss the best anaesthesia option for you.

Preparing for and Undergoing Hand Surgery

Once you and your hand surgeon decide on surgery, you’ll receive instructions on how to prepare. This typically involves a pre-operative consultation where your medical history is reviewed, the chosen surgical procedure is explained in detail, and potential risks are discussed.

Before the Surgery:

You might need some pre-operative tests.
If you’re having a general anaesthetic, you’ll need to fast (not eat or drink) for a specific period before the operation.
Inform your surgeon about any medications you’re taking, especially blood thinners.
Arrange for someone to drive you home after the procedure, as you won’t be able to drive yourself.

During the Surgery:

Hand surgery for Dupuytren’s disease is often performed as an outpatient procedure, meaning you can usually go home the same day.
The duration depends on the complexity and type of surgery (e.g., fasciectomy generally takes longer than needle fasciotomy).
The surgeon will make one or more incisions in your palm and/or finger(s), often in a zigzag pattern to prevent skin tightening during healing.
The diseased fascia and cords are carefully removed or divided, taking care to protect nearby nerves and blood vessels.
If a skin graft is needed (in dermofasciectomy), it will be applied.
The incisions are closed with stitches (sutures), and your hand will be bandaged. A splint might be applied to keep your fingers straight.

Your orthopaedic surgeon or hand specialist will guide you through each step, ensuring you feel informed and comfortable.

The Road to Recovery: Post-Surgery Care and Hand Therapy

Recovery after hand surgery for Dupuytren’s disease is a gradual process and varies depending on the type of surgery performed and individual healing factors. Commitment to postoperative care and rehabilitation is crucial for achieving the best possible outcome.

Immediately After Surgery:

Your hand will be bandaged, and possibly placed in a splint to support the corrected finger position.
Elevating your hand will help reduce swelling.
Pain is expected, but manageable with prescribed pain relief medication. Nerve blocks administered during surgery can also provide initial pain control.

The First Few Weeks:

Wound care: Keep the dressings clean and dry. Your surgical team will provide instructions on bathing and when stitches will be removed.
Splinting: You may need to wear a splint, often at night, for several weeks or months to maintain finger extension as tissues heal.
Hand Therapy/Physiotherapy: This is a vital part of recovery. A specialized hand therapist will guide you through specific exercises designed to:
- Reduce stiffness and swelling.
- Improve range of motion in your fingers and hand.
- Regain strength and coordination.
- Manage scar tissue.
Exercises: These may include gentle passive movements (where the therapist moves your hand) and active movements (where you move your hand yourself). Examples include active finger exercise and passive finger exercise focusing on bending and straightening the joints.

Longer-Term Recovery:

Recovery time can range from several weeks for simpler procedures like needle fasciotomy to several months for more extensive surgeries like fasciectomy or dermofasciectomy.
Scar Management: Once the wound is fully healed, scar massage techniques can help soften the scar tissue and improve its flexibility.
Returning to Activities: You’ll gradually resume daily activities. Driving is usually possible after a few weeks (check with your surgeon and insurance). Returning to work depends on your job type – office work might be possible sooner than manual labour. Heavy lifting and forceful gripping should be avoided for several weeks or months as advised.
Potential Complications: While generally safe, risks include infection, nerve damage (temporary or permanent numbness/tingling), stiffness, complex regional pain syndrome (CRPS), and recurrence of the contracture. Discuss these potential risks with your surgeon.

Consistent follow-up with your surgeon and hand therapist is essential to monitor progress and address any concerns during your Dupuytren’s surgery recovery.

Key Takeaways and Next Steps

Hand surgery for Dupuytren’s disease, particularly procedures like fasciectomy, can be highly effective in straightening bent fingers and significantly improving hand function when the condition becomes problematic.

Here’s a quick summary:

Dupuytren’s contracture causes fingers to bend due to thickened tissue (nodules and cords) in the palm.
Surgery is often recommended when the contracture interferes with daily life or prevents the hand from being laid flat.
Several surgical options exist, ranging from minimally invasive needle fasciotomy to more extensive fasciectomy and dermofasciectomy.
Recovery involves postoperative care, splinting, and, crucially, dedicated hand therapy and exercises to regain movement and strength.
While surgery aims to correct the bend, it cannot cure the underlying disease, and recurrence is possible.

If you’re experiencing symptoms of Dupuytren’s contracture, such as lumps in your palm or difficulty straightening your fingers, don’t hesitate to seek advice. Consulting with a hand surgeon or specialist is the best way to understand your condition and explore the most suitable treatment options for you.

Ready to discuss your options?

You can book a consultation with Mr. David Shields, a specialist in hand and wrist conditions, via this link: https://www.circlehealthgroup.co.uk/consultants/david-shields

Alternatively, you can email for an appointment: info@theupperlimbclinic.co.uk

Taking action can help you regain the use of your hand and improve your quality of life.